Long-term services and supports (LTSS) provide essential help with daily activities, such as eating, bathing, and managing medications, for older adults and people with disabilities. While some people receive these services in nursing facilities, many prefer to remain in their own homes and communities, supported by home- and community-based services (HCBS).

Like many states, California is transitioning to deliver select Medicaid LTSS through managed care (MLTSS), moving away from the traditional fee-for-service payment model. This shift offers significant opportunities to enhance coordination for people using HCBS and improve the state’s cost predictability. However, careful planning is essential to avoid disruptions in care and services.

As California and other states move to MLTSS, stakeholders can learn from the experiences of 24 states that have already made the transition. This explainer outlines practical strategies to support the transition, emphasizing the importance of robust care protections, strong provider networks, and proactive oversight. See also two companion fact sheets that summarize how states can address questions that HCBS users and providers have about transitioning to MLTSS, with a focus on continuity of care and provider payment.

The explainer and fact sheets were developed by the Center for Health Care Strategies through support from the California Health Care Foundation.